Chapter 4 - THE FIRST ALTERED MESSAGE
Daniel brought the papers to Margaret’s oncologist, Dr. Priya Shah.
She reviewed them.
“These are not chart notes.”
Daniel frowned.
“They look like chart notes.”
“They’re printouts of portal messages and home-care summaries.”
“Were they sent to you?”
“Some were.”
Dr. Shah opened the actual electronic record.
A message from Vanessa read:
Margaret refused anti-nausea medication again and would not drink prescribed supplement.
Margaret stared.
“That wasn’t true.”
Dr. Shah checked the date.
Margaret remembered.
“I took the nausea pill at lunch. I couldn’t keep the drink down afterward.”
Different.
Another message:
Patient increasingly oppositional about nutrition.
Margaret looked furious.
“I said the vanilla one burned my throat.”
The dietitian had even switched flavors after that complaint.
Daniel asked:
“Can someone edit these messages?”
Dr. Shah answered:
“Not after they are submitted, but the sender chooses what to report.”
So some records were not technologically altered.
Reality had been altered before it entered the record.
Dr. Shah also explained why the phrase “noncompliant” bothered her.
“It can hide more than it reveals.”
Daniel frowned.
“If someone doesn’t follow instructions, isn’t that noncompliance?”
“Sometimes.”
Then:
“Sometimes it means the instruction was intolerable. Or misunderstood. Or unaffordable. Or symptoms made it impossible.”
Margaret smiled weakly.
“Or the vanilla drink tastes like wall paint.”
Dr. Shah laughed.
Exactly.
Labels can collapse causes.
That mattered because Vanessa kept converting:
could not
into:
would not.
The distinction affected care.
If Margaret could not swallow because of pain, the answer was symptom control.
If she would not because of preference, the answer might be discussion.
Different problem.
Different response.
That was subtler.
Then Dr. Shah found something stronger.
One scanned home-care log contained a handwritten note:
REFUSED EVENING MEDS.
The original nurse copy said:
May you like
MEDS DELAYED 45 MINUTES DUE TO NAUSEA.
Someone had changed delayed into refused.
